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Corporate Compliance

4 months ago

Wilmington Delaware, New Castle County, DE, United States ChristianaCare Full time

ChristianaCare is searching for a Corporate Compliance & Privacy Auditor to join the team.This position will execute moderate-to-complex level audits and participate in the evaluation of the adequacy, effectiveness, and efficiency of internal controls and identify weaknesses, along with providing recommendations to mitigate those weaknesses. This position is required to be able to work under limited supervision.

Education and experience requirements:

At least one of the following degrees is required:

  • Associates or Bachelor's degree in Nursing (active/unrestricted license)

  • Associate or Bachelor's degree in Health Information Management (RHIA or RHIT)

  • Equivalent experience of 5+ years' experience in provider auditing, claims auditing, compliance auditing, quality assurance, and/or recovery auditing

  • Coding Certification (at least one of the following are required and are to be maintained as a condition of employment)

  • Certified Professional Auditor (CPMA); Certified Professional Coder (CPC); Certified); Certified Coding Specialist (CCS); In-depth knowledge of ICD CM, ICD PCS and CPT/HCPCS coding systems.

  • Must be proficient in DRG/APC structure, National Correct Coding Initiatives, ICD CM/PCS Official Guidelines, Outpatient Prospective Payment System and Coding Clinic References. Current working knowledge of encoder/grouper. Strong analytical and communication skills.

  • Candidates who hold a CCDS or CPC will be given consideration but will need to obtain an inpatient coding certification within 1 year of their hire date with the company.

  • Experience in auditing education techniques and methods preferred, but not required.

Principal duties and responsibilities:

  • Review documentation to ensure appropriate assignment of DRG, ICD-9 codes, CPT codes, and modifiers for facility-based and provider-based clinical documentation, medical necessity, and/or inpatient coding and has a high level of understanding in reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG and APR-DRG payment systems.

  • Maintain a working knowledge of coding guidelines, HIPAA, and CMS regulations.

  • Participate in the planning and scheduling of compliance projects.

  • Work closely with providers to ensure accuracy in the coding and documentation of service.

  • Train new providers in coding and documentation responsibilities.

  • Research compliance related coding questions upon request from departments and/or practices.

  • Identify and report potential audit and compliance risks.

SPECIAL REQUIREMENTS:

Must maintain current AAPC certification.

When you become an employee at ChristianaCare, you are joining a robust healthcare organization that truly cares about their patients and their caregivers. For the second consecutive year, Forbes magazine has ranked ChristianaCare as one of the best large health systems to work for in the United States Guided by excellence and love, our Caregivers enjoy a multitude of employee benefits that include:

  • Full Medical, Dental, Vision and other insurance benefits

  • 403 (b) with an employer match

  • Diverse and Inclusive culture

  • Generous paid time off with annual roll-over and opportunities to cash out

  • 12 week paid parental leave

About Christiana Care:ve

Headquartered in Wilmington, Delaware, ChristianaCare is one of the country’s most dynamic health systems, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. ChristianaCare includes an extensive network of outpatient services, home health care, medical aid units, two hospitals (1,227 beds), a Level I trauma center and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care and women’s health. ChristianaCare is a not-for-profit teaching health system with more than 260 residents and fellows. We are continually ranked by US News & World Report as a Best Hospital. With our unique, data-powered care coordination service and a focus on population health and value-based care, ChristianaCare is shaping the future of health care.